MEDICARE: REBECCA L BECKSTROM MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP14620	CA

General Provider Information

NPI Number	:	1689723132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L BECKSTROM MS, CCC-SLP

Provider Business Mailing Address
First Line	:	6924 HYDE PARK DR
Second Line	:	APT #320
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-2269
Country	:	US
Telephone Number	:	619-692-0622
Fax Number	:	619-692-6044

Provider Business Practice Location Address
First Line	:	7801 MISSION CENTER CT
Second Line	:	SUITE 104
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1313
Country	:	US
Telephone Number	:	619-692-0622
Fax Number	:	619-692-0644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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Directions to “ REBECCA L BECKSTROM MS, CCC-SLP” Practice Location

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